still not clear about scabie and HIV

Jul 13, 2007

Dear Dr. Bob,

First of all, you are awesome and a hero! I was wondering...about a year ago I broke out into a rash. It happened twice within the same month and usually after I exercised, but it would stick around for about 5 days. The second one was the worst and covered my face, chest and arms--no other symptoms, but I was worried that it was ARS. If it WAS ARS, it would have been at least 11 weeks after possible exposure (unprotected hetero sex, I'm the female). Is this too late for ARS, or is there such a thing as "too late for ARS"?

Then, a year later, I was diagnosed with scabies. I know that anyone HIV+ or HIV- can get scabies, but I read somewhere that scabies was an opportunistic infection for HIV in Asia. Is that true? Were they talking about regular scabies or Norwegian scabies (the article didn't distinguish)? Is it easier to get scabies if you have HIV? Or, if you have HIV, can you get scabies without skin contact (I have no idea where I got it)?

Also, after the scabies, I kept getting short bouts of folliculitus. Do you know if this is related to the scabies? If I had HIV, would I be getting folliculitus only a year after exposure (doesn't it take awhile for early symptoms to appear)?

Response from Dr. Frascino

Hello Losing Hope,

Let's start with a common sense approach that will simplify your situation and resolve your completely unnecessary conundrum.

If you placed yourself at risk for HIV, you need an HIV-antibody test three months or more after your last potential exposure. Period! It really is just that simple and just that straightforward. The only way to determine if you have HIV is to get an HIV test. Symptoms are notoriously unreliable in determining who is and is not infected.

I'll reprint some information about scabies from the archives below. Scabies is not an HIV-related opportunistic infection; however, scabies can be more severe and difficult to treat in folks with immune deficiency. HIV poz or negative, skin contact is not required to contract scabies.

Don't lose hope; just use common sense by getting HIV tested if you've placed yourself at risk. OK?

Dr. Bob

HIV and Scabies
Jun 25, 2007

Hello Dr. Bob:

I am a 43 y/o male who has been HIV+ for 4 years and not on meds. Recently, when being retested, I discovered my t-cells had dropped to 278 and my viral load was about 100,000 copies. So...it appears I will be starting meds very soon if my lab retest shows a lack of improvement. In the past week, I began experiencing what appeared to me as mite or spider bites on my left hand. That quickly developed into a trail of small welts and they started popping up on other areas of my body..including my genitals. I travel a great deal and feared I may have contracted Scabies or bed bugs. Last night I went to the local emergency room and concluded I had scabies. I was prescribed Permethrin 5% topical ointment which I applied all over my body, incuding my head. My questions to you are: 1. How subsceptible is my partner, who is not HIV positive. Although we have not had any sexual contact in several days, we cuddle, kiss and hug frequently. Should he treat himself with the ointment as well? 2. Since I am HIV + and not yet on meds, should I also be on the oral medication called Ivermectin? 3. Once treated, what is the likelihood that the scabies will return and reinfest my body?

Your prompt response is greatly appreciated.

Response from Dr. Frascino

Hello,

1. Anyone can get scabies, regardless of their HIV serostatus. Scabies is caused by Sarcoptes scabiei, a small mite that burrows beneath the skin and causes intense itching. Symptoms usually begin two-six weeks after infection in persons who have never had scabies before. For those with reinfection, symptoms can begin in one-four days. Transmission occurs primarily via direct body-to-body contact, including, but not limited to, sexual contact. It can also be transmitted via contact with clothes and bedding. Treatment with permethrin cream 5% (Elimite) applied to the total body from the neck down and washed off 8 to 14 hours later with a retreatment 1-2 weeks later is usually successful. Ivermectin (Stromectol) is not recommended as a first line treatment in uncomplicated cases. All family members and close contacts must be treated simultaneously. Bedding and clothing must be decontaminated via machine washing in hot water followed by machine drying on high heat or with dry cleaning.

2. No, see above.

3. No increased risk over the general population, assuming you follow the guidelines above.

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